The emergence of the COVID-19 pandemic drove a rapid widescale shift to telehealth services, widening existing disparities for underserved communities. According to the New England Journal of Medicine, one in four Americans does not have the digital literacy skills or access to internet-enabled digital devices to engage in video visits. Patients with limited English proficiency, limited digital literacy, low socioeconomic status or older age often lack the resources required to overcome the structural barriers to telehealth access.
Digestive Disease and Sciences states that these underserved patient populations benefit most from telehealth services, yet challenges from the lack of infrastructure prevent the long-term implementation of telehealth services.
As the son of Salvadoran immigrants who have limited digital literacy and limited English proficiency, I shouldered the responsibility of taking care of my family’s medical care. I set up telehealth visits with their providers when needed and accompanied them during their appointments to act as an interpreter, a role I often occupied before the transition to video visits. My parents’ health could have declined without my involvement due to the combined challenges of existing disparities and telehealth services.
As community members, we are responsible for promoting telehealth equity by bridging the digital divide in health care access through community service and encouraging institutional change.
As an employee at a remote chronic disease management company, I educated patients on how to take their blood glucose and blood pressure at home so that their primary care providers could review their vital signs remotely. It became clear that routine telehealth services were inhibited by the limitations of internet-capable devices or digital literacy skills. Even patients with capable devices lacked access to broadband internet or the ability to understand digital device information, preventing successful chronic disease management, particularly in older adults.
Despite inhabiting the largest city within Silicon Valley, San Jose residents face a digital divide that prevents access to essential services and resources. In response, the San Jose Public Library system established community-based programs focused on digital literacy enhancement and device access, such as the multi-lingual SJ Access initiative or the Older Adults Digital Engagement Project. These programs can serve as guidelines for other communities to create a networking foundation to close the gap in telehealth and other essential services.
Health programs such as Medicare and Medicaid, which receive federal funding, are required to provide language services in the patients’ preferred language. Yet, a third of the nation’s hospitals do not offer linguistically appropriate services. Health care systems should incorporate language interpreter access to ensure clear physician-patient communication in telehealth services, particularly for states such as California, which has 6.6 million residents with limited English proficiency.
Policy changes at the local, state and federal levels are required to ensure telehealth access to underserved communities facing existing obstacles to primary care. Elected officials have an obligation to advocate for policies that support continuing equitable telehealth services for vulnerable patients, including changes to Medicaid that guarantee fair costs for video and telephone visits.
At the individual level, we can inform others about the resources and services offered in our area to close the gap in telehealth disparities.
Here are available resources for Bay Area residents:
● SJ Access: a multi-lingual city-wide initiative through the San Jose Public Library to provide residents access to free Wi-Fi, device access and digital literacy programs.
● Older Adults Digital Engagement Project: a San Jose Public Library program that addresses the digital divide among older adults by increasing access to digital literacy programs and community resources.
● Neighborhood Tech Connect: A program set up by the Community Living Campaign to provide San Francisco older adults and people with disabilities with tablets, internet access and training to connect with family members and manage their health.
Brandon Aguilar of San Jose is a pre-medical student and a participant in Stanford School of Medicine’s Center of Excellence in Diversity in Medical Education’s LEAP program.
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